Autologous Chondrocyte Transplantation in the Treatment of Thumb CMC Joint Osteoarthritis

Abstract

Background: Degenerative thumb carpometacarpal (CMC) joint osteoarthritis is a common disease in middle-aged woman. Nevertheless, synovitis and initial cartilage damage starts earlier and then progressive degenerative arthritis develops, leading to joint narrowing with progressive exposure of subchondral bone, osteophyte formation, subluxation, and deformity involving also the surrounding joints. The aim of this study is to evaluate the outcome of the patients treated with autologous chondrocyte transplantation at thumb CMC joint. Materials and Methods: Ten cases of thumb carpometacarpal thumb osteoarthritis, stages II and early III, were treated by arthroplasty with the implant of autologous chondrocyte transplantation by open or arthroscopic technique. Preoperatively all patients had persistent pain reluctant to different kinds of nonoperative treatments for at least 6 months. Mean preoperative pinch was 3.2 kg. All patients had a limitation of abduction and flexion at maximal degrees. Ethic committee approval of our institute had been obtained. Fragments of 3 to 4 mm of cartilage were harvested under arthroscopy or by open technique from the wrist or elbow joint. Cartilage cells were sent to laboratory to grow on a collagenous biphasic matrix (Novocart). After 3 weeks, it has been possible to implant the chondrocyte-augmented scaffold in thumb CMC joint using fibrin glue or freeze them to have the second operation later. Ten CMC joint in 8 patients, all females, aged 42 to 68 years (M = 53 years) have been treated. Dominant hand was treated in 6 cases; 2 patients had bilateral operation. In 8 cases, the patients were operated by open technique, and dorsal ligaments reconstruction was associated to stabilize the CMC joint. Patients were reviewed at a mean follow-up of 6.5 years (range, 5-9 years). Results: Impairing pain disappeared in all patients, and full range of motion was obtained in all cases. Mean pinch increased to 6.5 kg, and grip also increased in all cases. No complications occurred postoperatively. Two patients had persistent mild pain, 1 resolved spontaneously after 7 months. One patient was lost at follow-up. Conclusions: The results obtained are encouraging and implanted cartilage has lasted in the majority of cases up to 5 to 9 years. Tissue reconstruction is developing and could be an optimal solution to restore normal cartilage in young patients in order to postpone more aggressive procedures to an older age. In cases of instability, it is necessary to associate a ligament stabilization procedure to avoid subsequent damage to implanted cartilage. A longer follow-up and a greater number of cases are necessary to definitively establish the usefulness of this procedure that has the advantage of being completely biological but has high costs.